Provider Demographics
NPI:1770563173
Name:TALLEY, DAVID R (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:TALLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7909 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE#110
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3425
Mailing Address - Country:US
Mailing Address - Phone:210-614-4544
Mailing Address - Fax:210-582-5522
Practice Address - Street 1:12709 TOEPPERWEIN RD
Practice Address - Street 2:SUITE#206
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3258
Practice Address - Country:US
Practice Address - Phone:210-564-8000
Practice Address - Fax:210-590-7945
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2009-08-26
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Provider Licenses
StateLicense IDTaxonomies
TXJ5920208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117314802Medicaid
TX117314802Medicaid
TX86W496Medicare ID - Type Unspecified